Thriving in an Unlicensed State
Written by Rhonda Steinke, ND
Practicing in unlicensed states can be a rewarding experience especially since these areas are lacking integrative healthcare. The key to creating a thriving practice is to plan carefully. The following recommendations on starting a successful career in an unlicensed state are based on my experience.
Do: Hire an Attorney and Accountant
Don’t: Use Inappropriate Terminology
Consider hiring an attorney and accountant to discover the legal and accounting framework that your business will have to operate under. This initial investment will save you time and money in the long run. Have the attorney look at state regulations that can affect your practice. They can be found in various areas such as Medical Practice Acts, Higher Education Acts, and Health Codes. Understanding regulations can prevent costly mistakes. For example, I've seen practitioners have to waste marketing materials after finding it necessary to change their title from "physician" to "doctor" and others forfeit inventory after discovering they could not compound botanical extracts in office. Some attorneys may recommend you avoid words such as "clinic, plan, patient, treat". They might suggest alternatives such as "office, recommendation, client, and support." Accountants will be able to differentiate important tax information for example some states do not tax supplements as they are considered food instead of retail items.
Do: Join Your State Association
Be involved with the state association and get in touch with as many Naturopathic Physicians as you can to get their opinion and perspective. I find most state associations are extremely supportive and have a strong peer network to discuss similar struggles and fears of working in an unlicensed state. It is also a good idea to find a mentor that has been working in an unlicensed state that is willing to assist as you begin the process of starting your business.
Do: Invest in Business Insurance
Find out what type of insurance best suits your practice. Business liability insurance will protect your entity and its assets from civil litigation. Malpractice insurance is available for ND's in unlicensed states but is questionable if truly protective. Some attorneys believe malpractice insurance in these states could be used against you since it is intended for those who "practice" medicine.
Do: Build a Trusting Referral Network
Don’t: Practice beyond Your Scope
Build relationships with other practitioners whom diagnose and prescribe and others specializing in practice such as IV nutrients, hormone prescription, acupuncture, etc. These contacts will be an asset for building your patient base and can provide supporting documentation that you are referring for medical diagnosis and treatment. In my practice, I chose to work with “clients” already diagnosed by conventional practitioners and referred out others until a diagnosis was established.
Holding a License to Practice Naturopathic Medicine is NOT Optional
Written by Carrie Runde, ND, AANP Board of Directors
As many reading this know, the road to becoming a physician is long. First, you have to excel in your many pre-med classes as an undergrad or post-bacc student. Once you are accepted into medical school, you complete four or five years of basic sciences, clinical sciences, and clinical rotations totaling over 310 credits. Throughout this process, hundreds of thousands of dollars (plus interest!) are spent on your accredited, doctoral education. When graduation rolls around, excited friends and family travel to AZ, CT, IL, OR, or WA to watch you cross the stage and be called “doctor” for the first time! New graduates and supporters alike are thankful for the completion of this arduous, yet transformative, process.
The new grad’s sense of liberation is ephemeral, however, as the reality of the upcoming board exams set in. This is truly the final hurdle between the newly minted naturopathic doctor and his or her ability to practice medicine. A passing score is needed to obtain a medical license in each of the jurisdictions that grant them to NDs. But what about those graduates who plan on working in states that have yet to license naturopathic doctors? What is the rationale behind holding an out-of-state license?
As we learn in our jurisprudence courses, it is illegal to call ourselves physicians, to diagnose, treat, and prescribe (read: practice medicine) in states that do not license naturopaths. New docs must remember this in unlicensed states! Just because one holds an Arizona license, for example, does not mean that he or she can practice medicine in an unlicensed state like Texas. This does not mean that NDs in these states should be license-less, however.
Simply put, medical professionals have medical licenses. Naturopathic physicians are medical professionals. The Department of Education recognizes our doctoral degree to be on par with our allopathic and osteopathic peers, which is why we are able to obtain most of the same government-issued educational loans as our conventional colleagues. These doctors, as well as chiropractors, nurses, and physicians’ assistants maintain licenses for public safety. Practitioners who hold licenses have received degrees from accredited medical programs, abide by legal and ethical standards, and fulfill yearly continuing education requirements in order to provide optimal patient care. By holding a medical license, you are telling the world you are a naturopath who has received accredited training as a family doctor and who stays current on medical practice as required in the state in which you hold a license. This distinguishes you from the online, diploma-mill “naturopathic doctors.” Even though your unlicensed state has yet to recognize you as a physician, you are minding the safety of your clients by adhering to the high professional standards associated with maintaining a physician’s license.
There are also important reasons related to your state’s future licensure. Holding a medical license in another state is proof that you are licensable. This is something that diploma-mill graduates cannot claim. This gives credibility with other medical professionals and legislators. Dr. Carol Rainville, a naturopathic doctor in Massachusetts explains that, “whenever I am educating people about naturopathic medicine I mention that I hold a license in Washington where I went to school. It gives people reassurance that I am the real deal. It’s also important for interacting with other professionals. Patients may not realize that you need to go to school and pass the boards to get a license, but other medical professionals do. And if you’re going to ask legislators to pass licensing laws, your position is more tenable with a license in your pocket.”
Maintaining your out-of-state license is an obligation to your state’s licensing efforts. Naturopathic doctors will be licensed in all 50 states eventually, and it will take effort from all of us to make it happen. An ND working hard on Maryland licensure, Dr. Emily Telfair maintains that, “a naturopathic medical license is one of the strongest legs we have to stand on as our profession establishes itself as a vital and active participant in health care in this country. And while one piece of paper cannot truly explain what it means to be a naturopathic physician, all of the steps that allow us to display that piece of paper in our offices begin to tell that story. There are moments in our story that connect us to other professionals who graduated from accredited medical schools and language within our story that is familiar to legislators who may otherwise question the validity of our request for a license. Holding a naturopathic medical license in an unlicensed state gives me confidence in knowing that what has been achieved in other states can happen where I live as well. Holding a Washington license reminds me that I am a physician and just because I can’t advertise myself as such in Maryland does not change who I am, what I know, or how I got here.”
For information about states’ licensing requirements, click here.